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Phantom tooth pain: a new look at an old dilemma.

UNLABELLED: The aim of this paper is to review the current knowledge of phantom tooth pain, a neuropathic facial pain disorder, thought to result from peripheral nerve injury. Phantom tooth pain is a deafferentation pain disorder of persistent toothache in teeth that have been denervated (usually by root canal treatment) or pain in the area formerly occupied by teeth prior to their extraction. The pain usually extends to the facial structures adjacent to tissues that have undergone deafferentation. The clinical characteristics, differential diagnosis, epidemiology, and treatment of phantom tooth pain are reviewed. Suggestions for further research include the need for controlled treatment trials and modification of current criteria. CONCLUSIONS: Phantom tooth pain has much in common with other phantom pain disorders. In the absence of controlled clinical trials specifically directed to phantom tooth pain, treatment should be guided by standards used for other neuropathic pain disorders. Revised diagnostic criteria for phantom tooth pain are proposed.

Journal Article↗

Masticatory tooth contact patterns: predicted and observed cuspid and first molar contacts in cuspid and group function.

Using the mouth as an "in vivo articulator," the bilateral nonmasticatory ("empty") contact patterns of opposing cuspid and first molar teeth were determined in two healthy subjects with well-defined cuspid function and two healthy subjects with well-defined group function. The electronically recorded "empty" contact patterns pertained to the static intercuspal position and dynamic laterotrusion to the right and the left. On the basis of the "empty" tooth contact patterns and the number of electronically recorded masticatory cycles of one masticatory sequence, we postulated two simple models that attempted to predict the masticatory ("functional") tooth contacts of one sequence of unilateral mastication of apple and banana. Statistical comparisons between the predictions of the two models and the actual ("functional") contacts of in vivo mastication showed that the models predicted fairly well the observed tooth contacts on the nonchewing-side of the mouth, but not the observed tooth contacts on the chewing-side of the mouth. In consequence, "empty" (nonmasticatory) tooth contact patterns should not be equated with "functional" (masticatory) tooth contact patterns.

Adult↗

A close correlation between electron spin resonance (ESR) dosimetry from tooth enamel and cytogenetic dosimetry from lymphocytes of Hiroshima atomic-bomb survivors.

PURPOSE: To estimate gamma-ray doses received by Hiroshima atomic bomb survivors using electron spin resonance (ESR) of tooth enamel and to compare the results with cytogenetic data. MATERIALS AND METHODS: Tooth enamel ESR was performed for 100 teeth donated from 69 Hiroshima survivors, and conventional cytogenetic examinations were conducted for 61 of the tooth donors. To evaluate possible contamination from dental X-ray exposure, which primarily affects the tooth's buccal surface, each tooth was divided into buccal and lingual parts for subsequent independent enamel isolation and ESR measurement. RESULTS: Almost 20 teeth showed considerably larger buccal doses than lingual doses, but most of these discrepant teeth were incisors and canines. The results are probably attributable to solar light exposure. In contrast, the buccal and lingual doses found in molars were similar. Conventional translocation data of lymphocytes and ESR-estimated doses of 40 donors of molars showed the dose-response for translocations to be almost the same as that expected from in vitro gamma-ray irradiation experiments. CONCLUSIONS: Both tooth enamel ESR and lymphocyte cytogenetics are useful measures for individual biodosimetry of acute radiation exposure, even half a century after the exposure occurred.

Aged↗

Influence of muscle pain tolerance on muscle pain threshold in experimental tooth clenching in man.

Ten adults and ten children exercised maximal voluntary tooth clenching until pains appeared in the jaw muscles, i.e. the muscle pain threshold of tooth clenching was determined. Subsequently, the subjects were instructed to exercise tooth clenching until they were forced to stop because of intolerable pains and exhaustion of the contracting muscles, i.e. the muscle pain tolerance of tooth clenching was recorded, and during these bouts of clenching the pain tolerance of tooth clenching was recorded, and during these bouts of clenching the pain threshold was also determined. In adults, determination of the pain tolerance decreased the pain threshold by 19%, and in children it either decreased the pain threshold by 20% or increased it by 56%. It is proposed to introduce the muscle pain tolerance of tooth clenching as an adjunct in the clinical examination of cases of facial pains presumed to originate from the jaw muscles, but the test should be interpreted with caution.

Adolescent↗

A new method for measuring nocturnal tooth contacts.

A new portable system for measuring nocturnal tooth contacts has been devised. This system was suitable for patients to take home and record tooth contacts by themselves. A micro photo sensor using optical fibres was applied to detect tooth contacts. The sensor and the target were accurately fixed to opposed molars, respectively on the same side, with removable metal attachments. Patients were instructed to set the attachment to their tooth each experimental night. In the present study, data was assembled for four or five nights in three subjects who were free of masticatory pain and dysfunction. Each subject showed an individual tooth contact pattern. It is suggested that this new system is useful and convenient for measuring nocturnal tooth contacts.

Adult↗

Cultured human and rat tooth papilla cells induce hair follicle regeneration and fiber growth.

The mesenchymal-epithelial interactions that characterize the early stages of tooth and hair follicle morphogenesis share certain similarities, and there is increasing evidence that mesenchymal cells derived from both mature structures retain interactive and stem cell-like properties. This study aimed to gauge the cross-appendage inductive capabilities of cultured tooth dental papilla (or pulp) cells from different species and ages of donor. Adult human and juvenile rat tooth papilla cells were implanted into surgically inactivated hair follicles within two different microenvironments. The human cells interacted with follicle epithelium to regenerate new end bulbs and create multiple differentiated hair fibers. Rodent tooth dental cells also induced new epithelial matrix structures and stimulated de novo hair formation. However, in many instances they also elicited mineralization and bone formation, a phenomenon that appeared to relate to their donor's age; the type of tooth of origin; and the host environment. Taken together, this study reveals that cultured dental papilla cells from postnatal mammals (adult, juvenile, and newborn) retain inductive molecular signals that must be common to both hair and teeth follicles. It highlights the stem cell-like qualities and morphogenetic abilities of tooth and hair follicle cells from mature humans, and their capacity for cross-appendage and interspecies communication and interaction. Besides the developmental implications, the present findings have relevance for stem cell biology, hair growth, tissue repair, and other biotechnologies. Moreover, the critical importance of considering the local microenvironment in which different cells/tissues are naturally or experimentally engineered is firmly demonstrated.

Adult↗

The effects of orthodontic tooth movement on the glycosaminoglycan components of gingival crevicular fluid.

In this study, gingival crevicular fluid (GCF) was collected from around a canine tooth, in children, before and during orthodontic tooth movement. The aim was to identify and quantify the glycosaminoglycan (GAG) components of GCF and relate them to tooth movement, gingival inflammation, plaque accumulation, pocket probing depth and GCF volume recorded at the site of sampling. GAG in GCF samples, collected for a 15-min period into microcapillary tubes, were separated electrophoretically, stained with Alcian blue and quantified using a laser densitometer. 2 GAG components of hyaluronic acid (HA) and chondroitin sulphate (CS) were identified. The increase in GCF volume during orthodontic tooth movement was only partly due to increased gingival inflammation. GAG levels varied with different types of orthodontic tooth movement. In GCF, levels of CS, in particular, may reflect the changes in the deeper periodontal tissues which could be monitored during orthodontic tooth movements.

Adolescent↗

CD 95 mediated apoptosis in embryogenesis: implication in tooth development.

INTRODUCTION: Understanding of apoptotic mechanisms involved in tissue shaping is of particular interest because of possible targeted modulation of the development of organ structures such as teeth. Research of CD 95 mediated apoptosis has been focused particularly on cell death in the immune system and related disorders. However, CD 95 mediated apoptosis is also involved in embryogenesis of many organs as the kidney, the lung, the intestine and tissue networks such as the nervous system. DESIGN: Narrative review. RESULTS: This review briefly summarizes the current knowledge of CD 95 mediated apoptosis in embryogenesis with possible implication in tooth development. CD 95 receptor and CD 95 ligand are found at early stages of tooth development. The data suggest some positive correlations with dental apoptosis distribution, particularly in the primary enamel knot where apoptosis occurs during elimination of this structure. CD 95 deficient (lpr) adult mouse tooth phenotype, however, did not show any alterations in final tooth pattern and morphology. CONCLUSION: To date studies of apoptotic machinery during tooth development show spatial localization of many of the components together with precise and localized timing of cell death. There is still much to be learned about the regulation and importance of apoptosis in tooth development. Nevertheless, the involvement of apoptotic regulatory mechanisms interplaying with other molecules participates to the cellular cross-talk in developing tissues, which opens possible targeted modulations as suggested, e.g. for future molecular dentistry.

Animals↗

The influence of sympathetic nerve activity on axial position of the rabbit incisor tooth.

Changes in position of the upper front tooth in response to sectioning and subsequent electrical stimulation of the cervical sympathetic nerves were studied in 25 anesthetized rabbits. The position was continuously recorded by an ultrasonic transit time technique. Sectioning of the nerves was found to induce an average tooth extrusion of about 7 microns. Sympathetic nerve stimulation for periods of 20-30 s caused intrusion of the tooth, with about 70% of maximum occurring at 2 Hz stimulations. The intrusive response was reduced by phentolamine. Neither atropine nor propranolol affected the stimulation response, but the latter drug led to marked extrusion of the tooth. In conclusion, the position of the rabbit's front tooth was found to be highly sensitive to alterations in sympathetic nerve activity to the vasculature of the tooth-supporting tissues.

Animals↗

Tooth brushing and social characteristics of families in 32 countries.

OBJECTIVES: To compare the reported tooth brushing behaviour among adolescents in relation to age, gender and parental occupation, family affluence, single parent family and at least one parent not working but staying at home. METHODS: Representative samples of 11-, 13- and 15 year old pupils in 32 countries completed an anonymous standardised questionnaire during school hours. RESULTS: Large differences in prevalences of reported tooth brushing were found between countries for both genders: from 16-80 % for boys and 26-89% for girls. In some countries the prevalence of more-than-once-a-day tooth brushing increased by increasing age, whereas in others it declined. High occupational status and family affluence were clearly related to a high prevalence of more-than-once-a-day tooth brushing. Children living in two parent families had higher prevalences of recommended tooth brushing in only a few countries. CONCLUSIONS: Within the European continent and in North America, gender, family affluence and parental occupation were significantly associated with reported tooth brushing frequency among adolescents. The association between family characteristics, such as absence of one of the parents and the supervisory role of the parents, and brushing behaviour of the children appeared to be rather weak and inconsistent.

Adolescent↗

Origins of tooth pulp-evoked far-field and early near-field potentials in the cat.

Electrical stimulation of the mandibular canine tooth pulp in barbiturate-anesthetized cats activated myelinated A-beta-fibers in the inferior alveolar (dental) nerve and evoked a complex pattern of short-latency potentials that were recorded epidurally from the cortex. Three far-field components ( FFPs designated I, IIa,b, and IIIa,b) and two early near-field components ( ENFPs designated P1 and N1) were identified from computer-averaged potentials recorded over the contralateral lateral sigmoid gyrus or ipsilateral presylvian /anterior coronal gyri. Several corroborative lines of evidence indicated that tooth pulp-evoked FFPs and ENFPs originate from the following generator sources: I, inferior alveolar (dental) nerve/semilunar (gasserian) ganglion; IIa,b, trigeminal lemniscal fibers from the principal (main) sensory nucleus; IIIa,b, thalamocortical fibers from the thalamic ventral posteromedial nucleus; P1, N1, cytoarchitectural area 3 on the banks of the coronal or orbital sulcus. The latencies and waveforms of volume-conducted, surface-recorded potentials were not significantly different from those recorded at putative generator sites along the trigeminal lemniscal projection system. The short latencies and distribution of surface- and depth-recorded tooth pulp-evoked potentials suggested bilateral, trisynaptic paths from peripheral nerve to cortical neurons. Amplitude measurements of FFPs and ENFPs recorded at the cortical, epidural surface were compared to calculated values based on a mathematical model of two concentric spheres of inhomogeneous media in which a single equivalent dipole is radially oriented at some distance from the center. The morphology and distribution of FFPs and ENFPs are discussed in relationship to source geometry. Surface- and depth-recorded tooth pulp-evoked potentials had recovery functions that were covariant with rates of stimulation. In addition, stimulation of putative generator sites along the trigeminal lemniscal system reproduced portions of the tooth pulp-evoked surface-recorded potentials. Selective ablation of trigeminal cortical area 3 abolished ENFPs and lesions of lemniscal brain stem sites abolished FFPs . Disruption of extralemniscal brain stem sites had no effect on the surface-recorded evoked potentials examined. These findings and other supporting evidence from previous studies imply that the projection of fast-conducting tooth pulp input to the cortex may subserve a nonnociceptive modality and participate in sensorimotor integration.

Afferent Pathways↗

Tooth color and reflectance as related to light scattering and enamel hardness.

Tooth color is determined by the paths of light inside the tooth and absorption along these paths. This paper tests the hypothesis that, since the paths are determined by scattering, a relation between color and scattering coefficients exists. One hundred and two extracted incisors were fixed in formalin, mounted in a standardized position in brass holders, and pumiced. A facet was prepared near the incisal edge on the labial plane to allow for Knoop hardness measurements with a 500-gram load. Light scattering by the enamel was measured in a 45 degrees/0 degrees geometry; light scattering by both enamel and dentin was measured in a 0 degrees/0 degrees geometry. The reflection spectrum of the tooth was measured from the labial plane with a spectroradiometer in a 45 degrees/0 degrees geometry, with standard illuminant A and standard illuminant D65. To include all volume-reflected light, we used entire-tooth illumination and small-area measurement. CIELAB color coordinates were calculated from the spectra. Neither spectra nor coordinates showed evidence of a contribution of fluorescence to tooth color. Averaged values and standard deviations for L*,a*,b* were 69.9 (4.1), 1.22 (1.4), and 17.9 (2.9), respectively. Both scattering coefficients averaged to 0.6 (0.4) mm-1; Knoop hardness number was, on average, 271 (39) kg/mm2. L* correlated with a* (r = -0.51), with the enamel scattering coefficient (r = 0.60), and slightly with hardness (r = 0.17, p = 0.03). The colors of 28 teeth from which the enamel was removed correlated strongly with the colors of the complete tooth.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemical Phenomena↗

Bilateral reflex vasodilation in the palatal mucosa evoked by unilateral tooth-pulp stimulation in the cat.

In a previous study in cats, we found that electrical stimulation of the tooth pulp caused blood flow increases at various sites in the ipsilateral oral mucosa (upper and lower gingivae, lower lip, buccal mucosa and tongue, and, notably, bilaterally in the palatal mucosa). Tooth-pulp stimulation is well-known to induce severe pain and to evoke autonomic reflex responses in other organs and tissues. The purpose of this study was: to confirm that tooth-pulp stimulation may indeed induce autonomically mediated vasodilator responses in the feline oral mucosa away from the stimulated tooth, and to test our hypothesis that the reflex pathway involves parasympathetic vasodilator fibers as efferents. Dynamic changes in palatal mucosal blood flow (PMBF), with lower lip blood flow (LBF) as a control, were investigated in anesthetized, cervically sympathectomized cats by means of Laser Doppler Flowmetry. Unilateral electrical stimulation of the maxillary canine tooth pulp produced hexamethonium-sensitive bilateral increases in PMBF in a stimulus-intensity-dependent manner, without an increase in systemic blood pressure; LBF increased only ipsilaterally. Bilateral section of the glossopharyngeal nerve roots had no effect on the vasodilator responses, while unilateral section of the facial nerve root or lesion of the pterygopalatine ganglion (PPG) abolished the response on that side. Intracranial electrical stimulation of the peripheral cut ends of the facial or glossopharyngeal nerve roots caused an increase in ipsilateral PMBF. These results indicate that unilateral tooth-pulp stimulation induces a bilateral reflex vasodilator response in the palatal mucosa mediated via parasympathetic vasodilator fibers that emerge from the brain stem with the facial nerve and reach the blood vessels via PPG. Although there is a dual innervation of the cat palatal mucosa by parasympathetic vasodilator fibers running via the facial and glossopharyngeal nerve roots, the latter are not involved in the bilateral reflex responses.

Animals↗

The role of MSX1 in human tooth agenesis.

MSX1 has a critical role in craniofacial development, as indicated by expression assays and transgenic mouse phenotypes. Previously, MSX1 mutations have been identified in three families with autosomal-dominant tooth agenesis. To test the hypothesis that MSX1 mutations are a common cause of congenital tooth agenesis, we screened 92 affected individuals, representing 82 nuclear families, for mutations, using single-strand conformation analysis. A Met61Lys substitution was found in two siblings from a large family with autosomal-dominant tooth agenesis. Complete concordance of the mutation with tooth agenesis was observed in the extended family. The siblings have a pattern of severe tooth agenesis similar that in to previous reports, suggesting that mutations in MSX1 are responsible for a specific pattern of inherited tooth agenesis. Supporting this theory, no mutations were found in more common cases of incisor or premolar agenesis, indicating that these have a different etiology.

Adolescent↗

Grouping of tooth surfaces by susceptibility to caries: a study in 5-16 year-old children.

BACKGROUND: The decline in caries has slowed and this may be indicative of variation in the susceptibility of differing teeth to caries. This study tests the hypothesis that in children, there are groups of tooth sites that exhibit differences in caries susceptibility. METHODS: Probit analysis of caries data collected from a 4-year longitudinal study of 20,000 schoolchildren aged between 5 and 16 years in 10 differing locations in the United States. RESULTS: The development of dental caries within the mouth followed a fixed hierarchy indicating that tooth surfaces show variation in caries susceptibility. Certain teeth and tooth sites have similar susceptibilities and can be grouped, the sizes of the groups vary. The most susceptible group consists of six tooth surfaces: the buccal pits and occlusal fissured surfaces of the first molar teeth. The second group consisted of 12 sites on the second molar and premolar teeth. The group formed by the least susceptible sites included the largest number of tooth surfaces and consists of the majority of the lower anterior teeth and canines. CONCLUSION: Variation in the caries susceptibility of tooth surfaces exists. Surfaces can be grouped according to caries susceptibility. An effect that reduces the cariogenic challenge of one of the sites within a group is likely to affect all the other sites within the particular group.

Journal Article↗

Clinical and socio-behavioral correlates of tooth loss: a study of older adults in Tanzania.

BACKGROUND: Focusing 50 year olds and above, this study assessed the frequency, extent and correlates of tooth loss due to various reasons. Frequency and correlates of posterior occluding support was also investigated. METHOD: A cross-sectional household survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. One thousand and thirty-one subjects, mean age 62.9 years participated in a clinical examination and completed interviews. RESULTS: The prevalence of tooth loss due to any reason was 83.5%, due to caries 63.4% and due to other reasons than caries, 32.5%. A total of 74.9% had reduced number of posterior occluding units. Compared to subjects having less than 5 teeth lost due to caries, those with 5 or more lost teeth were more likely to be females, having decayed teeth, confirming dental attendance and to be among the least poor residents. Compared to subjects who had lost less than 5 teeth due to reasons other than caries, those who had lost 5 or more teeth were more likely to be of higher age, having mobile teeth, being males, being very poor and to disconfirm dental attendance when having problems. Predictors of prevalence of tooth loss (1 or more lost tooth) due to various reasons and reduced number of occluding units followed similar patterns of relationships. CONCLUSION: The results are consistent with prevalence and extent of tooth loss due to caries and due to reasons other than caries being differently related to disease- and socio- behavioral risk indicators. Caries was the principle cause of tooth loss and molar teeth were the teeth most commonly lost.

Journal Article↗

Whole exome sequencing and cluster analysis reveal that EPB41L4A mutation may trigger tooth agenesis.

OBJECTIVE: To detect and analyze the correlation between commonly mutated genes and known genes associated with tooth agenesis in patients with non-syndromic tooth agenesis. The aim is to explore new genes that may be associated with tooth agenesis, to provide a genetic reference for its prevention as well as for the clinical diagnosis and treatment of tooth agenesis. METHODS: Genomic DNA was extracted from the peripheral blood of 18 congenitally edentulous subjects, and related gene mutations were identified by whole-exome sequencing. The genes related to maxillofacial development and the known pathogenic gene sequences of congenital tooth agenesis were selected for local alignment analysis of pairwise sequences, and the metric relationship of related sequences was determined. Hierarchical and fuzzy clustering methods were used for cluster analysis. RESULTS: Hierarchical clustering and fuzzy clusterings yielded consistent results. The EPB41L4A gene clustered with a large number of well-known and well-defined genes associated with tooth agenesis. From the perspective of cluster analysis, it can be inferred that the genes clustered together generally have similar functions. CONCLUSION: EPB41L4A, which is involved in the Wnt pathway, may be a candidate gene warranting further investigation.

Humans↗

A new method for assessing the prevalence of dental fluorosis--the Tooth Surface Index of Fluorosis.

A new index for measuring the prevalence of dental fluorosis, the Tooth Surface Index of Fluorosis (TSIF), was used to assess the condition in the permanent teeth of 807 children, aged 8 to 16, who had resided all their lives in one of seven Illinois communities with an optimal concentration of fluoride in its water or with 2, 3, or 4 times the optimal concentration. Fluorosis was absent in 84.5% of all tooth surfaces examined in the community with optimal fluoride. In contract, only 31.9% of tooth surfaces had no fluorosis in the community with 4-times the optimal fluoride level. In the optimal fluoride area, 79% of facial surfaces of maxillary anterior teeth, which are esthetically conspicuous, had no fluorosis, whereas only 15.8% of these surfaces in the 4-times optimal area were unaffected. The percentages of all tooth surfaces affected by fluorosis characterized by staining, pitting, or both were 1%, 8%, 19%, and 38%, respectively, in communities with 1-, 2-, 3-, and 4- times optimal fluoride. Differences in fluorosis based on maximum score for all tooth surfaces in a child were statistically significant (an extended chi 2 statistic) among all communities. First molars and incisors in children 8 to 10 years old were affected by more fluorosis than were the same teeth in children 13 to 16 years old. These teeth had been erupted for about 5 years longer in the older age group. The difference might result from abrasion or remineralization of these teeth in the older children or from greater consumption of fluoride by the younger children during tooth development.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗